The Edge Of Our Lives

You’re in a private residence with an engine company and a cop where you’ve all responded following a reported cardiac arrest.

Like so many of those calls, this one didn’t turn out as advertised. You’re with a 40-year-old guy, pale and slightly built, who’s confused and diaphoretic after you awaken him with D₅₀. He smells like urine.

A neighbor says he parked his car at the curb in his cul de sac less than 20 minutes ago after only a brief absence. According to the neighbor, he came back carrying a 7/11 coffee cup, which he spilled stumbling from his car toward his front door. When the neighbor checked on him a few minutes later, there was no answer at the door so she called 9-1-1.

The car is a 1960s-vintage Chevy Nova, and it’s barely alive. It’s nosed up to the curb, between two other cars. There’s damage to the right front corner, and the neighbor says it’s new. Part of the headlight is dangling from its socket like the anatomy of a bug-eyed cartoon character. The cop wants to see the man’s license and registration in connection with a recent hit-and-run incident a few blocks away, so you agree to walk the latter out to his car. The man enters the driver’s door and reaches for the glovebox, but suddenly he inserts the key in the ignition, starts the motor and tries to back away. The driver’s door is still open, so you’re being dragged backwards. You struggle with the driver for the ignition key, and he clamps his teeth on your posterior right arm. Fortunately, you’re able to grab the key and turn the engine off. But in the process you come very close to being run over by the left front wheel.  

Q. This wasn’t the first time I’ve ever found myself in serious personal danger. I was forced to decide quickly whether to let this guy go or try to stop him. We’re taught to think scene safety all the time, but it’s part of the job to risk our lives. How do you reconcile the two?

A. You said a mouthful, there. I agree with you about not having much time to make critical decisions—on scene, anyway. But I don’t think it’s part of our EMS responsibilities to risk our lives. At least, not routinely.

Q. What do you mean, “on scene, anyway?” Are you suggesting we could decide that stuff in advance?

A. Yes I am, precisely. Eventually, we’re all confronted with momentary quandaries that force us to choose between our own safety and the well-being of others. I think we need to think about those choices at length and in advance; during our quietest moments, when our minds are clear and uncluttered by alarms, sirens and radio traffic. We’ve been preplanning fires and other kinds of emergencies for years. I think this is another good application for that strategy. In fact, I think we should solicit the input of our closest family members in those decisions. It’s only fair. It may make them uncomfortable, but I think they deserve our candor.

Q. Maybe. But you’re kidding about the risks themselves, right? We risk our lives every day, just by responding emergent.

A. I’m just saying I think there’s a big difference between finding yourself in danger (and quickly managing the threat), and just accepting it as a normal feature of our work. The former is what a professional does. I think the latter is lazy, fatalistic and stupid. Think about the difference between coming to a complete stop at an opposing signal versus trusting your luck as you blaze through the intersection. In the former case, you minimize your risk by ensuring that if you get hit it’s at parking speed and nobody gets hurt. In the latter case, you accept the risk of seriously injuring your crew and the public.

Q. Still, I don’t think it’s exaggerating to say EMS is more dangerous than almost any other profession.

A. Is it really? We’ve suffered a lot of injuries and deaths, but I think a lot of that’s been our own fault. Think about construction workers, farmers, utility workers, auto mechanics, cops, shipbuilders, fishermen and highway workers. All of those folks face daily risks that are just as deadly as ours.

We’ll discuss these issues in much greater depth, and soon. But generally, I think we should all be questioning some of the dangers we’ve taught ourselves to simply accept over the years.

Thom Dick has been involved in EMS for 41 years, 23 of them as a full-time EMT and paramedic in San Diego County. He is the quality care coordinator for Platte Valley Ambulance Service, a community-owned, hospital-based 9-1-1 provider in Brighton, CO. Thom is also a member of the EMS World editorial advisory board. E-mail boxcar_414@yahoo.com.